1
|
Yang X, Zhang T, Yang X, Jiang J, He Y, Wang P. Medical resource utilization and the associated costs of asthma in China: a 1-year retrospective study. BMC Pulm Med 2023; 23:463. [PMID: 37993799 PMCID: PMC10666355 DOI: 10.1186/s12890-023-02685-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/28/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Despite evidence that severe and poorly controlled asthma are associated with more clinical unmet needs and intensive utilization of healthcare resources, limited data is available on severe asthma expenditure in China. The study aimed to assess Medical Resource Utilization (MRU) costs of asthma and explore the cost drivers in order to better understand the economic burden of the Chinese population suffered from asthma. METHODS A retrospective analysis was conducted using Chinese sampled national claim database. Patients aged 6 years and above with primary diagnosis of asthma and asthma-related medical visit/hospitalization during 2015 were included. Medication was used as a proxy per the GINA and China guideline to identify asthma severity (i.e. mild, moderate, and severe). multiple linear regression model was conducted to identify MRU costs drivers. RESULTS 7,254 patients diagnosed with asthma were included: 4,529 (62.4%), 2,200 (30.3%), and 525 (7.2%) had mild, moderate, and severe asthma, respectively. On average, each severe patient spent 6,782 Chinese Yuan (CNY) on asthma treatment and had 57.0% hospitalization rate during the year, 3.9- and 4.4-fold of the average of overall population (P < 0.001 for both). The proportion of patients experiencing exacerbation significantly higher in the severe asthma population (66.5%; P < 0.001) compared to mild (30.0%) and moderate (16.8%) groups. In subgroup with 1,660 samples had annual consecutive data, severe patients had annual cost of CNY 8,314 and 52.2% hospitalization rate. 13% of severe patients who had frequent severe exacerbation (≥ 2 events) experienced the highest annual average cost CNY 23,037, P < 0.001) whereas children aged from 6 to 14 with a lower annual cost of CNY 1,094.2, 1,660.2 and 3,020.2 for mild, moderate, and severe patients respectively. The multiple model identified degree of severity, control status, complications, age, and live region as independent drivers of MRU costs. CONCLUSIONS Chinese asthma patients bear heavy economic burden. Severe asthma associated with higher MRU (mainly from hospitalization) and costs compared with mild to moderate asthma in China. More efforts should be devoted to the control of the disease severity and complication as the main drivers of asthma cost.
Collapse
Affiliation(s)
- Xueer Yang
- College of Pharmacy, Jinan University, Guangzhou, 510632, China
| | - Tiantian Zhang
- College of Pharmacy, Jinan University, Guangzhou, 510632, China
- International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Ministry of Education (MOE) of China, Jinan University, Guangzhou, 510632, China
- Guangzhou Huabo Biopharmaceutical Research Institute, Guangzhou, 510010, China
| | - Xuanyi Yang
- College of Pharmacy, Jinan University, Guangzhou, 510632, China
| | - Jie Jiang
- College of Pharmacy, Jinan University, Guangzhou, 510632, China
| | - Yuwen He
- Department of Pharmacy, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China.
| | - Pei Wang
- School of Public Health, Fudan University, 130 Dong An Road, Shanghai, 200032, China.
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), Shanghai, 200032, China.
| |
Collapse
|
2
|
Kim JH, Lee H, Park SY, Kim JY, Choi SH, Kwon HS, Song WJ, Kim SH, Yu J, Song DJ, Cho YS, Lim DH, Cho YJ, Chang SI, Kim TB. Epidemiology of patients with asthma in Korea: Analysis of the NHISS database 2006-2015. World Allergy Organ J 2023; 16:100768. [PMID: 37128250 PMCID: PMC10148228 DOI: 10.1016/j.waojou.2023.100768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 05/03/2023] Open
Abstract
Background There has been a concerning increase in the prevalence and socioeconomic burden of asthma in Korea. Korea's National Health Insurance System (NHIS) covers insurance payment and claims management for all Koreans. Using National Health Insurance Sharing Service (NHISS) claims data. This study aimed to investigate patterns of healthcare utilization and direct cost in patients with asthma over a 10-year period. Methods In this retrospective population-based study, we examined NHISS claims records between July 2005 and June 2016 and investigated healthcare utilization among patients with asthma based on age group and severity of disease (non-severe asthma [NSA] and severe asthma [SA]). Results From 2006 to 2015, the total number of patients with asthma in Korea steadily increased from 743 968 to 2 286 309, with a corresponding increase in prevalence from 1.62% to 4.74%. The proportion of patients with SA decreased from 3.16% in 2006 to 1.56% in 2015; the proportion was consistently higher in men than in women. In addition, patients with SA had a higher cost per outpatient visit than patients with NSA, and the number of outpatient visits per year increased. The inhaled corticosteroid (ICS) prescription rate among patients with asthma decreased from 22.9% in 2006 to 15.7% in 2015. Furthermore, for a period of 10 years, more than 40% of patients with SA have been prescribed short-acting β-2 agonists (SABAs). Conclusions Although patients with SA comprised a small proportion of patients with asthma, they incurred greater medical costs per person. The pharmaceutical prescription pattern indicated a lack of ICS-based prescriptions and frequent SABA prescriptions.
Collapse
Affiliation(s)
- Jung-Hyun Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Korean Armed Forces Capital Hospital, Seongnam, South Korea
| | - Hyesung Lee
- Department of Biohealth Regulatory Science School of Pharmacy, SungKyunKwan University, Seongnam, South Korea
| | - So-Young Park
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Chung-Ang University Gwangmyeong Medical Center, Gwangmyeong, South Korea
| | - Ju-Young Kim
- Department of Internal Medicine, Dankook University Hospital, Cheonan, South Korea
| | - Sun Hee Choi
- Kyung Hee University School of Medicine, Seoul, South Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jinho Yu
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae Jin Song
- Department of Pediatrics, Korea University College of Medicine and Environmental Health Center for Childhood Asthma, Korea University Anam Hospital, Seoul, South Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae Hyun Lim
- Department of Pediatrics, School of Medicine, Inha University, Incheon, South Korea
| | - Young-Joo Cho
- Department of Internal Medicine, Ewha Women University School of Medicine, Seoul, South Korea
| | - Suk-Il Chang
- Department of Internal Medicine, Sung-Ae Hospital, Seoul, South Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Corresponding author. Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
| |
Collapse
|
3
|
Zhang A, Mao Z, Wang Z, Wu J, Luo N, Wang P. Comparing measurement properties of EQ-5D and SF-6D in East and South-East Asian populations: a scoping review. Expert Rev Pharmacoecon Outcomes Res 2023; 23:449-468. [PMID: 36889006 DOI: 10.1080/14737167.2023.2189590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
INTRODUCTION Euro-Qol-5 Dimension (EQ-5D) and Short-Form 6-Dimension (SF-6D) are the most commonly used generic multi-attribute utility instruments (MAUI) to calculate quality-adjusted life-years (QALYs) in East and South-East Asia. This study aims to systematically review and summarize current evidence on comparing measurement properties of EQ-5D and SF-6D in East and South-East Asian populations. AREAS COVERED Guided by the PRISMA systematic review and meta-analysis guidelines, a systematic literature search was conducted in databases of PubMed, Web of Science, MEDLINE, EMBASE and CINAHL (until June 2022) to obtain studies which compared measurement properties (feasibility, reliability, validity, responsiveness, and sensitivity) and agreement of EQ-5D and SF-6D in the populations. EXPERT OPINION In general, both EQ-5D and SF-6D had good measurement properties in East and South-East Asian populations; but their utility scores cannot be used interchangeably. Compared to the 3-level EQ-5D, SF-6D had better sensitivity and lower ceiling effects, but the comparison results between the 5-level EQ-5D and SF-6D were inconsistent across populations. This scoping review found that most studies did not consider order effects, did not specify the versions of SF-6D, and ignored certain measurement properties (reliability, content validity, and responsiveness). These aspects need to be further explored in future studies.
Collapse
Affiliation(s)
- Aixue Zhang
- School of Public Health, Fudan University, Shanghai, Hong Kong, China.,KeyLaboratory of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), Shanghai, Hong Kong, China
| | - Zhuxin Mao
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Antwerp, Belgium
| | - Zitong Wang
- School of Public Health, Fudan University, Shanghai, Hong Kong, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, Beijing, China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Pei Wang
- School of Public Health, Fudan University, Shanghai, Hong Kong, China.,KeyLaboratory of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), Shanghai, Hong Kong, China
| |
Collapse
|
4
|
Benidis KD, Tzortzaki E, Georgiou A, Zachariadou T, Adamidi T, Zannetos S, Bakakos P, Koulouris NG, Rovina N. Prevalence and Characteristics of Self-Reported Adult Asthma in Cyprus: A Population-Based Observational Study. J Asthma Allergy 2023; 16:215-226. [PMID: 36874225 PMCID: PMC9974514 DOI: 10.2147/jaa.s397784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/17/2023] [Indexed: 02/23/2023] Open
Abstract
Purpose To estimate the prevalence of asthma in adults, by gender and age, in urban and rural areas of Cyprus. Patients and Methods This was a population-based, random-digit dialing, telephone nation-wide survey to recruit patients with asthma. Among 8996 random landline-telephone contacted from the five major urban and rural regions of Cyprus, 1914 were finally met the age criterion of ≥18 years old and 572 completed valid screening for prevalence estimation. The participants filled a short screening questionnaire in order for asthma cases to be recognized. Then, asthma cases filled the main ECRHS II questionnaire and were evaluated by a pulmonary physician. All underwent spirometry. Data on demographic characteristics, educational level, profession, smoking status, Body Mass Index (BMI), Total IgE and Eosinophil Cationic Protein levels were measured. Results The overall prevalence of bronchial asthma in adults in Cyprus was 5.57% (61.1% men and 38.9% women). Among the participants with self-reported bronchial asthma 36.1% were current smokers, while 12.3% were obese (BMI >30). A total value of IgE >115 IU and Eosinophil Cationic Protein (ECP) >20 IU was found in 40% of the participants with established bronchial asthma. Wheezing and chest tightness were the most frequently reported symptoms in asthma patients (36.1% and 34.5%, respectively), while 36.5% experienced at least one exacerbation during the last year. Interestingly, most of the patients were under-treated (14.2% were on maintenance asthma treatment, and 18% used solely reliever medication). Conclusion This was the first study estimating asthma prevalence in Cyprus. Asthma affects almost 6% of the adult population, with higher prevalence in urban areas and in men compared to women. Interestingly, one-third of the patients were uncontrolled and under-treated. This study revealed that in Cyprus there is space for improvement in the management of asthma.
Collapse
Affiliation(s)
| | | | - Andreas Georgiou
- Respiratory Department, Nicosia General Hospital, Nicosia, Cyprus
| | | | - Tonia Adamidi
- Respiratory Department, Nicosia General Hospital, Nicosia, Cyprus
| | - Savvas Zannetos
- Department of Healthcare Management, Neapolis University Paphos, Paphos, Cyprus
| | - Petros Bakakos
- 1st Respiratory Department, National and Kapodistrian University of Athens Medical School, "Sotiria" Chest Hospital, Athens, Greece
| | - Nikolaos G Koulouris
- 1st Respiratory Department, National and Kapodistrian University of Athens Medical School, "Sotiria" Chest Hospital, Athens, Greece
| | - Nikoletta Rovina
- 1st Respiratory Department, National and Kapodistrian University of Athens Medical School, "Sotiria" Chest Hospital, Athens, Greece
| |
Collapse
|
5
|
Bhuia MR, Islam MA, Nwaru BI, Weir CJ, Sheikh A. Models for estimating and projecting global, regional and national prevalence and disease burden of asthma: a systematic review. J Glob Health 2020; 10:020409. [PMID: 33437461 PMCID: PMC7774028 DOI: 10.7189/jogh.10.020409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Statistical models are increasingly being used to estimate and project the prevalence and burden of asthma. Given substantial variations in these estimates, there is a need to critically assess the properties of these models and assess their transparency and reproducibility. We aimed to critically appraise the strengths, limitations and reproducibility of existing models for estimating and projecting the global, regional and national prevalence and burden of asthma. Methods We undertook a systematic review, which involved searching Medline, Embase, World Health Organization Library and Information Services (WHOLIS) and Web of Science from 1980 to 2017 for modelling studies. Two reviewers independently assessed the eligibility of studies for inclusion and then assessed their strengths, limitations and reproducibility using pre-defined quality criteria. Data were descriptively and narratively synthesised. Results We identified 108 eligible studies, which employed a total of 51 models: 42 models were used to derive national level estimates, two models for regional estimates, four models for global and regional estimates and three models for global, regional and national estimates. Ten models were used to estimate the prevalence of asthma, 27 models estimated the burden of asthma – including, health care service utilisation, disability-adjusted life years, mortality and direct and indirect costs of asthma – and 14 models estimated both the prevalence and burden of asthma. Logistic and linear regression models were most widely used for national estimates. Different versions of the DisMod-MR- Bayesian meta-regression models and Cause Of Death Ensemble model (CODEm) were predominantly used for global, regional and national estimates. Most models suffered from a number of methodological limitations – in particular, poor reporting, insufficient quality and lack of reproducibility. Conclusions Whilst global, regional and national estimates of asthma prevalence and burden continue to inform health policy and investment decisions on asthma, most models used to derive these estimates lack the required reproducibility. There is a need for better-constructed models for estimating and projecting the prevalence and disease burden of asthma and a related need for better reporting of models, and making data and code available to facilitate replication.
Collapse
Affiliation(s)
- Mohammad Romel Bhuia
- Asthma UK Centre for Applied Research (AUKCAR), Usher Institute, The University of Edinburgh, Edinburgh, UK.,Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Md Atiqul Islam
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Bright I Nwaru
- Asthma UK Centre for Applied Research (AUKCAR), Usher Institute, The University of Edinburgh, Edinburgh, UK.,Krefting Research Centre, Institute of Medicine, University of Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden
| | - Christopher J Weir
- Asthma UK Centre for Applied Research (AUKCAR), Usher Institute, The University of Edinburgh, Edinburgh, UK.,Edinburgh Clinical Trials Unit, Centre for Population Health Sciences, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research (AUKCAR), Usher Institute, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
6
|
Amini F, Jaladat AM, Atarzadeh F, Mosavat SH, Parvizi MM, Zamani N. A review on the management of asthma in the Avicenna's Canon of Medicine. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2019; 16:/j/jcim.ahead-of-print/jcim-2018-0148/jcim-2018-0148.xml. [PMID: 31527294 DOI: 10.1515/jcim-2018-0148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/29/2018] [Indexed: 12/28/2022]
Abstract
Introduction In this study, we attempted to identify medicinal plants for treating asthma by investigating Persian Medicine (PM) sources. Methods In the present review study, materials concerning asthma were assessed by the (most) reliable source of PM (Canon of Medicine) written by Avicenna. Recommended medicinal plants for treating asthma were extracted from this book. Likewise, the electronic databases were used for investigating the pharmacological properties of offered herbs. Results The signs and symptoms of "Rabv" discussed by Avicenna are very similar to the asthma in modern medicine. Avicenna dichotomized asthma causing into pulmonary and non-pulmonary ones, including asthma with the heart, liver, or stomach origin. Overall, 14 medicinal plants were mentioned for the treatment of asthma presented in Canon of Medicine, including celery, juniper, dodder, chamomile, fennel, quince seed, black caraway, lavender, hyssop, squill, anise, absinthe, asafoetida, and common polypody. Conclusions PM prescribes medicinal plants for treating asthma, based on each patient's symptoms and trigger factors.
Collapse
Affiliation(s)
- Fatemeh Amini
- Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Mohammad Jaladat
- Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Atarzadeh
- Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Hamdollah Mosavat
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mahdi Parvizi
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrindokht Zamani
- Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
7
|
Kontodimopoulos N, Stamatopoulou E, Brinia A, Talias MA, Ferreira LN. Are condition-specific utilities more valid than generic preference-based ones in asthma? Evidence from a study comparing EQ-5D-3L and SF-6D with AQL-5D. Expert Rev Pharmacoecon Outcomes Res 2018; 18:667-675. [PMID: 30048194 DOI: 10.1080/14737167.2018.1505506] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Systematic discrepancies have been shown in utility values derived from different instruments. This study compares utilities from the condition-specific AQL-5D and the generic EQ-5D-3L and SF-6D in an asthmatic population with heterogeneous health-related quality of life (HRQoL), disease severity, and control status. METHODS A consecutive sample of 104 patients diagnosed with asthma completed a survey containing the Greek versions of SF-36, EQ-5D-3L, and AQLQ(s). Treatment adequacy was assessed with the Asthma Control Questionnaire (ACQ), and asthma severity according to Global Initiative for Asthma 2016 guidelines. Association and agreement between instruments were assessed with Spearman's correlation and Bland-Altman plots. RESULTS AQL-5D utilities exceeded (p < 0.001) those from EQ-5D-3L and SF-6D. There were weak-to-moderate correlations (<0.5) between most dimensions of AQL-5D, and those of EQ-5D-3L and SF-6D, and strong correlations between similar dimensions of EQ-5D-3L and SF-6D. Significant differences (p < 0.001) were observed throughout the visual analog scale (VAS), asthma severity and asthma control subgroups, with AQL-5D consistently higher than EQ-5D-3L and SF-6D. CONCLUSIONS All instruments distinguished between differing degrees of asthma control, but only AQL-5D discriminated between asthma severity and HRQoL as well. Although the relatively small sample warrants caution in interpreting the subgroup results, this study contributes to the growing number of comparisons between condition-specific and generic preference-based instruments.
Collapse
Affiliation(s)
- Nick Kontodimopoulos
- a Faculty of Social Sciences , Hellenic Open University , Patras , Greece.,b Division of Management , "KAT" General Hospital , Athens , Greece
| | | | - Aikaterini Brinia
- a Faculty of Social Sciences , Hellenic Open University , Patras , Greece
| | - Michael A Talias
- c Faculty of Economics and Management , Open University of Cyprus , Nicosia , Cyprus
| | - Lara N Ferreira
- d ESGHT , University of the Algarve , Faro , Portugal.,e Centre for Health Studies & Research-CEISUC, University of Coimbra , Coimbra , Portugal
| |
Collapse
|
8
|
Müller A, Ráthonyi G, Bíró M, Ráthonyi-Ódor K, Bács Z, Ács P, Hegyi G, Bácsné Bába É. The effect of complex climate therapy on rehabilitation results of elderly asthmatic and chronic obstructive airways disease (COPD) patients. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|